Book reviews

This book contains 28 chapters describing in detail the approaches to the spine. Beginning with the superior cervical spine the author progressively descends to give an analysis of the different possible approaches to each surgical segment of the spine. Considerable space is given to the anterior approaches as illustrated by the four routes of access to the thoracolumbar junction presented by the author. Each chapter presents an illustration showing the operative position of the patient and the site of skin incision and describes the advantages and disadvantages of the left and right-sided approaches. Operative photographs (clearly demonstrative) are used to illustrate the successive stages of dissection down to the spine and emphasis is given to the possible difficulties that may be encountered. Helpful "advice" is given at the end of each chapter with a reminder of the points which may lead to a modification of the initially proposed technique, e.g. the positions of postoperative drainage, possible enlargement of the operative field, correction of intraoperative accidents, etc. A brief summary of the appropriate level of approach according to the pathological condition to be treated is given to aid in the understanding of the proposed operative indications. A short bibliography (English language literature) of the main publications in this field is also given. This very didactic work will be of considerable usefulness to surgeons with a long experience of spinal surgery, as well as to those who are beginning their careers in this field. Indeed, on reading this book the surgeon will undoubtedly feel that the problems he has, or will eventually encounter, have been carefully analysed and that an appropriate solution to them has been offered.

~~~8vo. pp.270. Gottingen, 1827. ^tl Essay on the Operation of Poisonous Agents upon the jiving Body. By John Morgan, f.l.s. Surgeon to Guy's Hospital: and Thomas Addison, m.d. Assistant Physician to Guy's Hospital.?Svo. pp. 91. London, T th"lE ^.l ee vvol'ks, the titles of which we have prefixed to ls article, are important contributions to our toxicologiknowledge. The first, which is a complete systematic eatise, is throughout worthy of the author's previous re-|h ation. Comprising a far more extended literature of t e subject than any previous toxicological work can preofn ^to; jt contains, at the same time, more ample details ^ he effects of poison on man, derived from the author's Pr hk~legal exPerience; f?r Professor Christison has p ? a^y been consulted in a greater number of cases of 'soning, subjected to juridical investigation, than any p \0r British practitioner. The Experimental Essay on (j^ls?ning by Oxalic Acid, published conjointly by Dr. of Geneva, and himself; and the elaborate and rptls-erly Essay on Arsenic, contained in vol. ii. of the bu^i dC^?ns Medico-Chirurgical Society of Edinin.1.' had placed the Professor's talents for toxicological estigation in a very favorable point of view: and the i,"sa! ?1 the present work will not fail to convince all c Partlal persons, that the same acuteness of judgment, actlieate c^lem'cal knowledge, and extensive reading, which author formerly displayed on isolated branches of No toxicology, have been brought, in this treatise, to the elucidation of the science in general.
The original chemical details contained in this treatise are particularly valuable, and cannot fail to be most acceptable to practitioners. The author has evinced a thorough practical acquaintance with the methods of detecting minute quantities of poisons in complex fluids, and lias simplified and perfected the methods of analysis previously suggested by Orfila and others. The processes he has related are delicate, conclusive, and easily managed. Some are novel, and preferable to any previously proposed?
and there is scarcely any, the accuracy of which he has not ascertained by frequent trials, under most diflicult circumstances.
The second work is by Professor Marx, of Gottingen, the erudite author of the " Origines Contagii." It is as yet incomplete, the portion of it before us being only the first part of the first volume. It is distinguished by the general peculiarity of the German school, that is, by a profound acquaintance with the whole literature of the subject, good and bad; an historical view of which is presented to the reader, without that critical sifting of the chaff from the grain, which by the authors of other countries would be deemed requisite. This work is intended by Professor Marx to comprehend a view of toxicology in all its relations. As a preparation for it, he remarks, that he has been for many years occupied in considering the subject, and in observing cases in medical practice. He has undertaken a series of experiments on various animals, for the elucidation of the more interesting and complex subjects of toxicological inquiry. He proposes to investigate the modus operandi of poisons; the causes of the varieties in their action; to ascertain the medium, that is, the systems or organs, through which poisoning takes place; what are their characteristic symptoms; what effects are produced by them in the body, as ascertainable by post-mortem examination; and the mode of cure, whenever that is practicable. This investigation, with the completion of the general historical details, will occupy the first volume.
In the second, poisons will be treated of specially: and under the several poisons, it is proposed, after having given a view of the literature of each, to ascertain its modus operandi in man, as well as in animals; the symptoms which it produces; the causes of death, and the kind of death; the |1ost-mortem appearances in man and animals; the mode of treatment; their use as an article of the materia medica, under which head the dose in which it Is poisonous will be indicated. The foreign names and most important synonyms will be given, chiefly with a view illustrate the writings of the ancients. The author has Extended his literary inquiries into writings devoted exclusively to criminal j urisprudence, and into the voluminous " Acta Sanctorum;" and from these sources he will derive jnany curious and some useful facts. A work so comprehensive, executed by a man of talent, judgment, and Earning, cannot fail, when completed, to be acceptable to the profession.
The essay of Messrs. Morgan and Addison has been Written under a strong impression of the importance of the ?bject of their inquiry; which appears to them to be not merely a question as to the medium by which poisons operate on the animal economy, but also as to the mode in }vhich all morbid phenomena are produced in the system; ,n short, to involve the elucidation of morbid phenomena i Produced by local agents, of every description, upon the 'vjng body. It is designed, then, to illustrate the theory j?' Medicine. Their essay is divided into two parts: a relation of the theories of former experimentalists, and an CxPerimental attempt to establish their own.
Of the importance of toxicology as a science, it is almost ^"perfluous to offer an observation. Independent of the ?"Solute necessity of its cultivation in relation to medical Jllrisprudence, it has unquestionably supplied the groundwork for an improved theory of the materia medica. The 7^?dus operandi of remedial agents was very imperfectly "own prior to the modern investigations of toxicological ^Perinientalists; and a proof of this assertion may be gatliered from a view of the opinions contained in the works Cullen, and even Murray. The general fact that agents, >o\vever applied, have the same kind of operation on the 'ving body, was formerly unknown; and the study of their Physiological actions has much contributed to illustrate U'eir therapeutic operation. "The study of toxicology? Says Dr. Christison, " has led to the rejection from the P' actice of medicine of a host of popular remedies, the offspring of empiricism, which were either totally useless or Positively prejudicial." , .
,e ?hject of the science of toxicology is fourfold: it Sllpplies antidotes for the various poisons; it furnishes the Physiologist with valuable instruments of research in his ,,,vestigations into the laws of the animal economy; it aids the physician in his inquiries as to the action of many energetic drugs; and it collects from the numerous branches of medical knowledge, as well as from collateral sciences, the materials of the most important department of medical jurisprudence.
Dr. Christison considers that toxicology has been more successfully cultivated than any other branch of medical jurisprudence, and chiefly because the opinions of medical men have more influence than in any other variety of judicial proceeding. In cases of poisoning, many causes combine to concentrate the weighty part of the proof in the medical evidence.
The proof of the fact, or of death having been occasioned in the manner alleged, can very seldom be drawn, as in other cases of homicide, from ge~ neral evidence, or from any thing else than medical testimony. This evidence is the more important, that the proof of poisoning also commonly infers proof of the intent: f?r on such trials it is impossible, as in other trials, to entertain the question whether death was the consequence of deliberate purpose, or of sudden fury, or of an act of se Ifdefence.
After a luminous exposition of the objects and importance of toxicology, Dr. Christison proceeds to develope the views which have influenced him in the composition of his work.
Having alluded to his own frequent medico-legal engagements, as some warranty for executing the present treatise, he comments on the omissions of practical points in existing works, possessing in other respects high reputation and scientific excellence. Some inquiries have not been noticed at all, and others very cursorily handled; and these defects he ascribes to the attention having been too exclusively turned to the means by which particular poisons may be proved to have been the cause of death; whereas, the questions which actually occur in medico-legal practice are much more diversified. Dr. Christison has endeavoured to supply these defects, in his chapters on General Poisoning and on the Diagnosis between the Effects of the Irritant and Narcotic Poisons and the Effects of Natural Disease.
Medical testimony is required, first, before the coroner in England or the sheriff in Scotland, as a sort of preliminary investigation; and, secondly, before the higher criminal courts. In the former, the question to be decided is, whether there is a certainty, probability, or possibility of poisoning, in a general sense. In the latter, the prisoner is charged with administering a particular poison. But in Treatises on Poisons. 137 some instances the evidence of the particular poison is merely presumptive, and that presumption not strong, so that the charge is substantially one of poisoning in a general sense; and convictions have been obtained in some tHals in Scotland, where no satisfactory proof existed what poison had been given.* Dr. Christison dissents from the ?pinion expressed by almost all continental medical jurists, who affirm the insufficiency of the proof derived from the ^vidence of general poisoning alone. " It is very likely9 "e admits, " that the proof of general poisoning from medical evidence alone, can never amount to more than a strong Probability. But the medical probability may be so high that, in conjunction with other circumstances of general evidence, no rational being can entertain a doubt that Phoning has been perpetrated." J he chapter on General Poisoning contains valuable Practical remarks, which will be sought in vain in Orfila, 0|^ other writers on toxicology. (Vide Orfila, Toxicologic &cncra/e; ii. 605.) When the charge made is of poisoning \V some particular poison, it is investigated by chemical j*rial}sis, by the morbid appearances found in the dead )Qdy, by the symptoms during life, and by the effects of the Suspected poison on animals. Or. Christison has thus ar-'anged his investigations of particular poisons.
treating of the symptoms observed in man, Dr. C. has ll0t followed the example of Orfila. The latter has tran-Scribed a list of complete cases: the former has given a general account of the effects of each poison. We think a ,evv selected cases preferable to either plan, as conveying 'astruction in a more natural and striking form. The operation of many poisons is various in different indiviuuals, but the differences^^ referable to a the narration of an example, as it ?cc"{"r?*. systematic treatise on Toxicology. He has discussed also the treatment to be pursued in the principal varieties 01 poisoning. We proceed to analyse the work more closely-It consists of two parts, to which is added a brief appen* dix.
The first part treats of general poisoning, and Is divided into three chapters, of which the first treats of the physiological action of poisons ; the second, is " of the evidence of general poisoning," as ascertainable by symptoms, by morbid appearances, by chemical analysis, and by moral proof; and the third, treats briefly of " imaginary, pre" tended, and imputed poisoning." Part the second includes the individual poisons, and consists of thirty-eight chapters. Chapter the first is on the Classification of Poisons, which our author, adopting physiological action as the most convenient basis of arrangement?
has divided into irritant, narcotic, and narcotico-acrid, properly rejecting the class of septic, which Orfila had admitted. The same distribution has been adopted by Professor Bernt,* and there can be no doubt of its superior accuracy, whether practical utility or scientific accuracy he considered. In detail, it may be open to some objection; but it is the only arrangement which connects the poison intimately with the symptoms and pathology.
Chapter the second treats of Irritant Poisons generally* and contrasts the symptoms and morbid appearances ot natural disease with those produced by this class of poisons-Then follow the most important individual poisons of thf class, and these occupy the work down to the twenty-fourth chapter. The twenty-fourth chapter is on Narcotic poisons, and contrasts the effects of them with the effects o\ natural disease. This class occupies five chapters. Chaptc' twenty-ninth takes up the subject of the Narcotico-acrid Poisons, and they are continued through the nine succeeding chapters.
To attempt a detailed analysis of a work so comprehen* sive, would be inconsistent with the limits which can he assigned to it in our Journal; nor, indeed, would it be very practicable to give a clear and instructive abstract of the whole treatise, which will be readily understood when state that the skilful condensation of the materials collected rp,r,^1S0I? divides their operation into local and remote. e local effects are of three kinds. They corrode or che-'cally decompose the part to which they are applied ; or, 1 "out immediately destroying its organization, they in-infl726 ?r *rJritale or> without producing either corrosion, "animation, or irritation, they make a peculiar impres-??n 0n the sentient extremities of the nerves, unaccompaled by any visible change of structure. Many of the r>tants (as arsenic, for example,) are, in common speech, 'ed corrosives, but they do not occasion chemical decom-'] 't'on: it is by means of inflammation, and its effects ?ne, that any breach of continuity is produced.
; wim, aujf UlCaV/ll Ul l/UIUlilUUJ 13 piuuutcu* tli 1 ^ristison adopts the term remote, in preference to j e JVore common phrase, general action, because the latter g P ies an action on the general system, or whole body.
.ctl an affection of the entire system is, however, rare: pr ,s 0ne or more of the important organs only which suffer J>?the indirect action. This remote action of poisons is eIj illustrated by the effects of oxalic acid. Concentrated t|) c acts as a corrosive by destroying the gelatine of fue aP'lnal textures, yet it never kills by destroying the (ellCtl?n ^e stomach. It has proved fatal to man in j ^ minutes, and to a dog in three. Nor does it always Uce, when swallowed, symptoms of an injury of the oniach; for death is often preceded by tetanus or apo-* xy? or mortal faintness. Hence death commences, so to de tk ? 'n sP*nal niarrow, brain, or heart; and, in fact, th is most rapid under circumstances in which the sto-jjjjCh is least injured, namely, when the acid is considerably Concerning the channel by which the '^nion ^as taken Poisons is excited, some fluctuation o p , toxico-PWe. Until very' recently, the opinions of ?^ents of !?S>sts has been very much guided by 1 to assent ^agendie; and scarcely has any one .. venoUs abto the opinion that poisons are transmittal y fo j0rption into the circulation, and thenc however, )l'ain or other organ remotely, affected.
Messrs. Morgan hypothesis has been controverv,?VP already alluded. Addison, in the essay to which w?.
to be m0st con-Vle theory which these gentlemen be deduced from s,stent with sound reasoning, and also y experiment, is contained in the following-proposition: "That all poisonous agents produce their specific effects upon the brain and general system through the sentient extremities of nerves, and through the sentient extremities of nerves only; and that, when introduced into the current of the circulation in any way, their effects result from the impression made upon the sensible structure of the blood' vessels, and not from their direct application to the bra10 itself." (Essay, &c. p. CO.) And to this theory Dr. Christison has given the sanction of his approbation.
Messrs. Morgan and Addison have arrived at their conclusions, partly from certain assumptions and reasonings and partly from experiment. They assume that such is the rapidity with which death takes place from some poisons, that the absorption of the poison is impossible; and hence, as it is absurd to suppose that nature employs two modes ot effecting the same purpose in the animal economy, absorp' tion never can be the direct medium of transmission; that the phenomena of sensation, and some of the morbid effects of mechanical injuries, analogous with the effects of some poisons, occur without the absorption and subsequent application of any material agent to the brain or other organs affected; and, finally, contending for a common medio"1 through which all morbific agents produce their remote or general effects, they reject the notion that absorption sup' plies that medium, in the sense contended for by Brodie, Magendie, &c.
After an attentive consideration of tlieir reasoning and facts, and a comparison of them with others already before the public, we do not hesitate to express our dissent frovn their hypothesis. Their analogical reasoning appears to us inconclusive, their experiments exceptionable, and the inferences deduced from them untenable, or liable to considerable doubts.
That absorption is the direct medium by which the influ~ ence of poisons is conveyed to the brain or other organs remotely affected, is the opinion which they have controverted. This opinion, in our judgment, is full as plausible as that now proposed by our authors; either of them, hoWever, demands further experiments to confirm or refute it.
We beg to-make, in this place, a few remarks on the phenomena of sensation, and on the sudden mortal effects of some mechanical injuries, in relation to the present subject.
Sensation, an ultimate fact in physiology, is a function performed by a special apparatus, that is, by the nerves ot special sense, and by the ramifications of the posterior d^ki k?se which Mr. C. Bell has denominated ?uble nerves; and, however it may be employed as an iteration, ^as but one analogy with the effects of poisons, t ?ely, rapidity of transmission. Now, it is experimenl[Y demonstrated of many poisons, that when they are pplied either to the nerves of sensation or to those subserent to voluntary motion, their remote effects are not Produced. Neither is the integrity of these nerves in a Il*ib to which poison is applied at all requisite for the full fid rapid production of its remote effects. Hence it appears at whatever analogy may be supposed to exist between e sensations and the effects of poisons, the medium through "ich their influence is transmitted is not the same: conse-H?ently} that there must be some apparatus connected with the brain and spinal marrow, &c. independent of the nerves sensation and volition, through the medium of which the Phenomena of poisoning may be sometimes excited with a rapidity like that of sensation.
n? e concede to Messrs. Morgan and Addison, h^t the medium through which poisons, commonly so called, TT5 CltlTlCAL ANALYSES. volition are excluded, and the authors have not mentioned the sympathetic nerve and ganglionic system. We pi"e" surae, however, that this must have been in their contemplation; and, if such was their opinion, it was susceptible of some illustration by direct experiment. We cannot, however, avoid expressing our expectation that the result of such experiments, if they had been instituted, would have been unfavorable to the views of Messrs. Morgan and Addison* (Vide Milligan's Magendie,p. 97.) In those slight or severe gunshot wounds and other mechanical injuries, from which sudden mortal effects are said to have occurred, without there being any perceptible sig'J of violence, it can never be satisfactorily proved that mortal faintness was not produced by mental emotion. Mental emotion is known to be capable of producing such effects; and it is probable that, when such cause is absent, these mortal effects are referrible to sudden and painful sensations* rF? tetanus from mechanical injury, as an illustration of the theory of Messrs. Morgan and Addison, we decidedly object.
Authentic histories of tetanus, thus occasioned, do not mention its occurrence till after the lapse of some days, and what processes may have been going on during that time 13 unknown.
It may hereafter turn out that this illustration is decidedly unfavorable to their mode of explanation.
Poisons, it appears, then, may produce their effects with a rapidity somewhat like the phenomena of sensation, and sensations may produce morbid phenomena in the general system like the effects of poisons; but sensations are transmitted by an apparatus through which the remote effects of poisons are not produced: neither is the integrity of sensation essential to the action of some poisons. Sensations and mental emotion can produce fatal effects; but if death from either commence, as is probable, in the cerebro-spina* system, indirectly affecting the heart, &c., the medium through which the former operate is familiar; and with regard to the latter, it may be safely affirmed to constitute no formidable opposition to the theory of Magendie, &c. The notion that the rapid effects of some poisons cannot, by possibility, be attributed to venous absorption, is obviously gratuitous; and no attempt has been made by Messrs. Morgan and Addison clearly to point out by what system 01 nerves they conceive them to be transmitted. Nevertheless, we are far from thinking that there has been any experimental demonstration of the theory that poisons are necessarily conveyed to the parts affected in their remote action; but there are some strong probabilities in its favor.
It is well ascertained, for example, that the blood is impregnated by the poison. It is known also that the rate of *en?Us absorption influences the rapidity and degree of the effect of poisons; and so far as any direct experiments have been made to ascertain in how short a time poisons can traverse the system, the result is favorable to the theory of iVIagendie; and, finally, experiment demonstrates that the remote effects of poisons are produced independently of that system of nerves which has the closest connexion with the cerebro-spinal system. We proceed to give the proofs 111 support of these probabilities. ^ A case of poisoning by oxalic acid was communicated to t|T* ^hristison by Dr. Arrowsmith, which proved fatal in lrteen hours. Six hours after the poison was swallowed, ?nie leeches were applied to the region of the stomach, and Vere almost immediately poisoned. " They were healthy," 3s Dr. Arrowsmith, "small, and fastened immediately. n looking at them in a few minutes, I remarked that they .I(j not seem to fill, and, on touching one, it felt hard, and ^mediately fell off, motionless and dead. The others Ve'e all in the same state. They had all bitten, and the arks were conspicuous, but they had drawn scarcely any ood."# This is an isolated fact, but it appears to be sufc'ently well attested. Since Dr. Arrowsmith made this servation, M. Verniere has pointed out the extreme sus-Ceptibility of the medicinal leech to the effects of poisons.
After a fatal dose of extract of nux vomica had been j.
rus* into the paw of a dog, M. Verniere applied a tight "ol mio uie paw of a dog, ivi. Vermere appnea a ugni I'gature around the limb ; warm water was y ejected into the jugular vein to as great an yanimal could safely bear, and the ligature was then rem Half an hour was allowed to elapse, which in ordinary c,rcumstances would have been much more 1 , totally to enable the poison to act, but the animal remai tQ ^affected. The ligature was next replaced, but so . u After having injected almost two pints of water into the veins of a dog of ordinary size, I introduced into his pleura a small dose of a substance, with whose effects I was fa ml" liar. I was surprised to see the effects only take place several minutes after the period at which they usually shoW themselves.
the question relative to the necessity for venous absorption and cerebral contact, as connected with the operation of prisonous agent9, in precisely the same state as he found Mr. Brodie admitted (incautiously, we think,) that the ]apid effects of some poisons could not be transmitted through the medium of absorption, which medium he had Previously contended for where the effects were developed ftiore slowly. Hence he assumed a double medium of communication with the brain in the operation of poisons. Our authors assume this probable mistake of Mr. Brodie (the ejection of absorption as the medium by which the most rapid effects of poisons are conveyed,) as an indisputable truth, and comment rather sharply upon the inconsistency his philosophical creed. We agree with them in think-^nS' that " it is contrary to all fair analogy to suppose that w -?v u i3 Luuiuu^ lu tin lciii ciiiaiugj lu supjjusc mat.
an>' variety observed in the effect of a local agent can essentially depend on the medium by which it is carried into he system;" and we think they would have no objection to that poisons, in a concentrated state, must act remotely P rough the same channel as the same poisons in a milder 0rro, and hence that the more rapid effect produced by a Co?centrated poison is in itself no argument for any parti-Cular channel of communication ; and, as in experiments Where the effects are more slowly developed, the phenomena are more easily observed, the milder mode of produces such phenomena appears the most likely, we think, to en&ble us to detect this disputed channel. This inference of Mr. Brodie, so eagerly seized on by The concentrated state of poisons obviously augments the rapidity of their effects; and we may observe, en pas~ sunt, that the substance experimented with by Professor Hering is but little poisonous. In addition to the state ot concentration, we beg to suggest that the physical proper" ties of a poison may also influence the rapidity of its effect' Prussic acid is the poison by which the most rapid effects have been produced. Now, prussic acid is very volatile; it boils at 80? F ; and is it unreasonable to suppose that, when exposed to the heat of the blood, as in dropping into the jugular vein, its very volatile nature in the concentrated state may so facilitate its transmission by the blood to remote parts, so as to render it unnecessary to call in the aid of any other channel? In cold-blooded animal* its effects are less sudden; and when the vessels of any p?r* are tied before the part is touched with the prussic acid, i*s action is prevented ; but the previous division of the nerves of a part has no such effect.
We are not aware that any more direct or conclusive evidence exists to prove that poisons are actually conveyed to the parts remotely affected; but we think the preceding facts and observations render such an opinion probable, that they weaken the objections brought against it froni the great rapidity of the remote action of some concentrated or gaseous poisons. affections has been made out, it is highly probable that the seat of such pathologic state is in the medulla spinalis; and, from experiment, it seems no less probable that the action of strychnia is almost peculiar to the same part of the cerebro-spinal system. For proofs of these opinions vif refer to the works of Ollivier, Abercrombie, of Bellingers C. Bell, and Magendie and Delille. It may be worth while, indeed, to quote two experiments performed by |he two last-mentioned gentlemen, with the Upas tieute, which Pelletier and Caventou inform us contains strychnia for its active principle.
After relating an experiment in which, the spinal marrow having been divided at the occiput, the tetanic convulsions followed the employment of the poison as usual, tliev performed the following: "Eight drops of upas, diluted with water, were injected into the pleura of a strong o?o ? at the same instant a piece of whalebone was forced doW? the whole length of the vertebral canal; the whole of spinal marrow followed the whalebone when it was wit"* drawn from the vertebral canal. Ten minutes after tne destruction of the spinal marrow, the circulation continued) and there was no convulsion.
" In another experiment, the same quantity of upas was injected into the cavity of the peritoneum of a dog: tne moment the 'tetanus' manifested itself, a piece of whalebone was forced down the vertebral canal, commencing, with the first cervical vertebra: the tetanus ceased in , fore paws when the whalebone reached the dorsal regi?n> it continued, on the contrary, in the posterior extremitieS' which ceased to be convulsed when the piece of whalebone reached the caudal extremity of the vertebral canal-(Orfila, Toxicologic generate, ii. 369.) Now, the preceding considerations, and the facts connected with them, serve to explain, first, how very different were the quantities of poison administered to the two dogs; and, secondly, how much more considerable was the quantity directed towards the spinal marrow in the inoculated dog than in the other. Nor is it altogether groundless to presume (from a remark which occurs in the following experiment,) that the connexion of the two arteries, by means of an inelastic tube, would retard the flow of blood in the uninoculated, and thus further diminish the quantity of the poison sent to the brain. The therapeutic experience of their reasonings and experiments; and that, if their theory be the true one, it must be proved to be so by further investigations; and we beg to ask, if the result in the two last experiments had been just the reverse of what it was, that is, if the uninoculated animals had been poisoned by the blood of the inoculated animals, whether it would not have been easy for them to say, " this is no proof against our theory: the poison came in contact with the 4 nerves of the inner coat of the blood-vessel' (p. 79,) before it reached the brain, and in this way was its influence transmitted.
Nor could that assertion be refuted. Hence their "vaunted" experiments do not offer to us an experiment^11 cruris.* Now, we venture to presume that the results of analogous experiments will be found the reverse of those which they have obtained. But the experiments must be modified.
We beg to suggest that concentrated prussic acid, strychnia &c. in large doses, be tried; and, as of course the inoculated animal will, under such circumstances, be speedily destroyed, respiration should be maintained artificially. the blood be strongly impregnated with the poison, and cif culate freely, we confidently anticipate that the uninoculated animal will experience its fatal influence. The theory of Messrs. Morgan and Addison will then repose on their inconclusive reasonings for its only support, and the pr?" bability of the views of Magendie, Barry, &c. will be increased. But an experimentum cuteis will still be a desideratum.
It is scarcely necessary to add, that the treatment of p?'~ soned wounds recommended by Dr. Barry remains entirely unaffected by the experiments and speculations of our authors ; whilst we regret to say that their criticisms of D,% Barry are not particularly candid. Indeed, the supercilious and oracular tone which pervades the essay is rather misplaced in a first attempt at physiological speculation.
With these remarks we conclude our notice of the es-ay of Messrs. Morgan and Addison, and proceed to consider Dr. Christison's chapter "on the Evidence of General Poisoning." The investigation of the evidence of general poisoning is purely medico-legal. It comprehends an account ot the various kinds of evidence by which the medical jurist is enabled to pronounce whether poisoning, in a general * We recommend to our authors' consideration the experiments of Magend'e 011 the vena porta, into which he injected substances of a poisonous nature* By what neivons fibrils is that vein supplied? pense (that is, without reference to a particular poison,) is ^possible, improbable, possible, probable, or certain. It 'kewise comprises an appreciation of the circumstances v Hch usually lead the unprofessional, as well as the professional, to infer.correctly or erroneously, a suspicion of such poisoning. (Christison, p. SO.) A he evidence by which the medical jurist is enabled to P'onounce on the existence or non-existence of#poisoning 1,1 Seneral, and to determine the subordinate questions that l a.te to it, is derived from five sources: 1st, symptoms Uringlife; 2, appearances in the dead body; 3, chemical ^'Jalysis; 4, experiments and observations on animals; and, ? certain moral circumstances, which are either inseparainterwoven with the medical proof, or cannot be accuately appreciated without medical knowledge.
I. Of the evidence from symptoms. So lately as during the latter part of the 18th century, ^Pinions were grounded almost exclusively on the symptoms, y^outthat time the infallibility ofsuch evidence began to be doubted, and it is nowlaid downbyevery esteemed writer on ??edical jurisprudence, that these symptoms, however exquisitely developed,can never justify an opinion in favor of more than high probability. i)r. Christison  If a person, immediately after swallowing; a solution o' a crystalline salt, which tasted purely and strongly acid, is attacked with a sense of burning in the throat, and then in the stomach, and vomiting, particularly of bloody matter; imperceptible pulse and excessive languor; and dies in halt an hour, or, still more, in twenty, fifteen, or ten minutes, Dr. C. knows of no fallacy which can interfere with the conclusion that oxalic acid was the cause of death. N? parallel disease begins so abruptly and terminates so soon, and no other crystalline salt has the same effects. Should a person be taken several times ill with symptoms of general inflammation of the mucous membranes, and each time after partaking of a suspected article of food and drink, tbe proof of the administration of arsenic would be very strong indeed, and it would be unimpeachable if at length a nervous affection succeeded at the usual period. Or, above all, suppose several persons, who have partaken of the same dish, are seized about (he same time with nearly tl?e same symptoms of irritation of the mucous membranes, thc proof of general poisoning would then be unequivocal.
To return from these exceptions. The chief characteristics usually ascribed to the symptoms of poisoning, considered generally, are, that they commence suddenly, aIlt^ prove rapidly fatal; that they increase steadily; that they are uniform in nature throughout their course; that they begin soon after a meal,* and that they appear whiie the person is in a state of perfect health. These are general facts, but all liable to exception. In instances of slow criminal poisoning, and of poisoning whilst a person is labouring under natural disease, they do not hold good. Cases of the latter description are generally very embarrassing; for if, instead of medicine, a poison be administered, the symptoms occasioned by which resemble the natural disease, suspicion may not arise till it is too late to collect evidence. Now, although the characters common to the symptoms of general poisoning are by no means universally applied" ble, yet, considering the little knowledge possessed by the vulgar of the action of poisons, and, consequently, the rude nature of their attempts to commit murder by poisoning? the exceptions will not be numerous; and (he chief characteristics will often enable the jurist to say that poi-* The negative evidence on this point is favorable to the person accused* and sometimes decisive against poisoning. soiling vvas possible, probable, or highly probable; which, on 611 raora^ evidence is very strong, may be quite eu?ll *-? ^ec'^e *^e case? ar|d, although they can never s0 . to say that poisoning was certain, they will . detunes entitle him to say, on the contrary, that it was 1 P0ss,ble; and, when the chemical or moral evidence I 0ves that poison was given, the characters of the symp-...r,ls lnay be necessary to determine whether it was the of death. tile '^ink it will be convenient to continue, in this place, symptomatology of the different classes of poisons, as &hl ras*ec^ w'th the symptoms of various natural diseases; 'ough, in so doin^, we depart widely from the arrangeof Professor Christison. wa;:y-lur perforation, are a sense of something giving ij|n. n e pit ol the stomach, acute pain gradually extenda ?Vci ^le whole abdomen, great tenderness and tension, excessive prostration, &c. c. Ruptured duodenum is rare' and requires no particular notice, d. Drinking cold wate when the body is heated sometimes produces sudden deatn> and not uncommonly instantaneous death. Sometimes j produces apoplexy,"and in some instances cholera. Of a diseases, this last is, however, the most embarrassing, 0,1 account of its frequency and peculiar symptoms; and soine cases of irritant poisoning, says Dr. Christison, cannot D certainly distinguished by their symptoms from cholera, in some others, where the physician has been able to ascei tain the symptoms in detail, the distinction may be drawn- it is sometimes rapidly fatal, for instance within an hour* very often lasts a whole day, or even longer.
b. Epilepsy, distinguished by convulsions and abolition of sense, is generally a chronic disease, and has sometime* precursory symptoms. The fit begins violently and abruptly. The patient cannot, in general, be roused by external stimuli. In fatal epilepsy, the paroxysm generally lasts long, sometimes more than a day. Epilepsv is scarcely ever fatal in the first paroxysm.
c. The diseases of the spinal cord which, producing convulsions, delirium, and coma, may be confounded with narcotic poisoning, are extravasation of blood into the spinal cord; inflammation of the membranes; and inflammation and ramollissement of the cord itself. These diseases are not very probable sources of fallacy, but they serve to show the necessity of examining the spinal corn and its membranes in all judicial cases of alleged narcotic poisoning, especially where death has not been rapid. comparing; the effects of poisons with these diseases, n'c observe, generally, that poisoning with the narcotics has not of course any precursory symptoms, except by fortuitous concurrence. It has happened most frequently amongst the young, especially of the female sex; and the person may not have been corpulent or disposed to the diseases above alluded to. The effects of the common narcotics, when they J)rove fatal, begin not later than an hour, or at the utmost two hours, after they are taken: most frequently they beg"J in fifteen or thirty minutes. Hence, if it can be proved that the nervous symptoms under which a person died did not begin till several hours after he took food, drink, or medicine, it appears almost, if not absolutely, certain that a narcotic poison cannot have been the cause of death-There are some exceptions to this, but the rule wil* hold generally. With respect to the commonest of the narcotic poisons, opium, the symptoms never occur tin after the interval of ten, twenty, or thirty minutes; and the deleterious gases, and hydrocyanic acid and its compound!?} are the only poisons which act more instantaneously. Except with these latter, the sopor from poisoning is at first imperfect, and increases gradually, though sometimes very rapidly. In the sopor of apoplexy, it is possible to rou?e the patient to consciousness; but, on the other hand, with some narcotics, and particularly with opium, the person may be roused from the deepest lethargy, if he bespoken to in a loud voice, or forcibly shaken, or if water be injected into the ear.
Few people die of pure narcotic poisoning' who outlive twelve hours, and the greater number die much sooner, in eight or six hours. On the other hand, the narc?tic poisons rarely prove so rapidly fatal as apoplexy sometimes does. Apoplexy decidedly may occasion death lr* considerably less than an hour. The narcotic gases and prussic acid are the only narcotics which prove so rapidly fatal. The shortest known period in which death has been occasioned by opium is three hours.
In relation to epilepsy, it may be observed that, if we except some cases of poisoning with hydrocyanic acid and the narcotic gases, the effects of narcotic poisons are gra-^ual, although their progress toward their extreme of v iolence is often rapid. In abrupt cases of poisoning with hydrocyanic acid, the poison, under certain conditions, will ho found in the body; while, in sudden poisoning with the narcotic gases, the nature of the accident is rendered ob-^'ous (o a cautious inquirer by the collateral circumstances. A he variety of poisoning with which epilepsy is most apt to be confounded, that is, with hydrocyanic acid, has hitherto always proved fatal within half an hour after the symptoms 'Jegin, unless the dose has been small, and given repeatedly.
3. Of the symptoms of the narcotico-acrid class, as compared with the signs of natural disease.
The poisons of this class are all derived from the vegetable kingdom. They have a double action; the one local and irritating, the other remote, and consisting of an impression on the nervous system. In large doses, their narcotic effects are most conspicuous; in small doses, their ^ritant action. Their most conspicuous effect is injury of the nervous functions, and the symptoms are so analogous to those from narcotic poisons as not to require any distinct sPecification. They seldom prove fatal if the case last above twelve hours, that is, by their narcotic action. The Poisonous fungi and digitalis are, however, exceptions to this remark.
II. Of the Evidence from morbid Appearances. r^he appearances after death which are really morbid, and which may be produced by poisons, are, from one great class, the signs of inflammation of the alimentary canal in J!s progressive stages; in another class, the si?;ns of congesion within the head; and in the third, a combination of the enects o( the two foregoing classes. But these appearances are not invariably occasioned by the poisons which usually cause them, and most of them are exactly similar to those N". 37?jVo, \ ^ ftew Series. Y left by many natural diseases. In general, therefore, the morbid appearances alone can never distinguish death 0} poison from the effects of natural disease. , Unusual lividity and early putrefaction were formerly much relied on as proofs of poisoning, but they are alike unfounded, and do not even justify suspicion. Arsenic? indeed, appears to have the power of preventing putrefaction under certain circumstances. In connexion with tn symptoms and the general evidence, the appearance attei death, by pointing out the nature of the previous illness, may furnish decisive evidence when the moral proot Is strong; and, again, in cases of alleged imputation of p?K sorting, they are necessary to determine whether a poison actually found in the body was introduced during life ?r after death.* And, in cases where no doubt can be enteruiivi uuain* itnuj in tascs w uciu nu uuuui can uc , , tained that poison was taken, the evidence from morn' appearance may be necessary or useful for settling whetne such as is seen in animals poisoned with arsenic or l0(j )1C ac'^> *s ai* unequivocal sign of inflammation. (P.
i. Ulceration and perforation are alike signs of natural ,sease and of poisoning. The co-existence of scirrhus fishes a ground of distinction. The perforation from J'niple gelatinization of the coats, without proper inflam-Uaiory action, is the most puzzling and remarkable vaiiety tion of the brain, the result of violence; or in sudden death from fracture of the skull; or from hanging', and where no previous sign, referrible to disease of the stomach, hatI existed.
The opinion of Hunter, supported by Allal' Burns, remains unrefuted, we think, by the observations 01 the French pathologists.* Now, in perforations produced by the irritant poisons, the margin is commonly of a peculiar colour: for example* yellow from nitric acid, brown from sulphuric or the muriatic acids, orange from iodine. But, says Dr. Christison, an infallible criterion, and one of universal application, 155 tlie following1: Either the person dies very soon after the poison is introduced, in which case vital action may not be excited in the stomach; or he lives long enough for the ordinary consequences of violent irritation to ensue. In t*'e former case, part of the poison will be found in the stomach; in the latter, the deep vascularity, or black extravasation, around the hole, and in other parts of the stomacn, will at once distinguish the appearance from a spontaneous perforation. Spontaneous erosion is very generally combined with unusual whiteness of the stomach, and there never any material vascularity. (See trial of Angus tor t'1 murder of Margaret Burns, 1808, lor an illustrative oxample.) 2. On the morbid appearances left in the body by tn? narcotic poisons, contrasted with the effects of natura disease.
The morbid appearances which Ihe narcotic poisons leave in the dead body are commonly insignificant, and, slight Q* they are, are not by any means invariably found. Cong'^b tion, extravasation, and the simple apoplexy of y.1' Abercrombie,f are alike the consequences of natural disease and narcotic poisoning'; for, with respect to the lattei? Dr. Christison says, "it might even be a fair subject o inquiry whether death from some narcotic poisons at | such as opium, is any thing else than death from simp e apoplexy." (P. 499.) Opium, however, haa produced e*"* travasation of blood; and congestion is not an unusual tor;^uence ?f poisoning by it. (P. 54-1.) There is reason believe that, in some cases of poisoning by opium, putrefaction takes place speedily. ret P?'son'n& by hydrocyanic acid, the eye is said to Si &''stening and staring appearance, as during life. c? has been observed in several instances; and such is ?,j? the case after death from carbonic acid gas. Dr. aft riSj1S?n reinarketl the same fact very distinctly six hours he Gr ea.th> in a woman who died of cholera; and it has 1 en noticed in cases of death taking place during the epi-Ptlc paroxysm. riii I he odour of prussic acid is oftentimes exhaled by the 1 ood, but not always; and it is sometimes perceptible in blood, even when it is not so in the stomach. Schubartn Sto*-7 if jL0S result of his researches (Christison,568,) that, tjlele "ose is sufficient to cause death within ten minutes, the/58CU^ai ?^our wiH always be remarked in the blood of Not jleart' lu,,g's? and great vessels, provided the body have a . e?n exposed to rain or to a current of air, and the exho 10n be made within a moderate interval, twenty-four jjj>er.s> instance: but if the dose has been so small that Hih 1S Prolo"Sed ^or fifteen, twenty-seven, or thirty-two Po ^en? even immediately after death, it may be imbern, J? remark any of the peculiar odour, evidently eVgause ^e acid is rapidly discharged by the lungs : and, Uii 11 ^en the dose is large enough to cause death in four lj u es5 the smell may not be perceived, if the body have to ? *n a sPaci?us apartment for two days, or exposed ra'n for a few hours only.
?>l ^le Evidence of Poisoning from chemical Analysis.
ralK. e c j m\cal evidence, in charges of poisoning1, is gene-aU {j' '! vyith justice, considered as the most decisive of 't def6 anc^es ?fproof. It is accounted most valid when then i^tt ^le P?'son 'n the stomach, intestines, or gullet; ?r ftiel ? niattcr vomited; next in articles of food, drink, an ,C,"e' w^'c^ t'ie sufferer has partaken; and, lastly, ^vhich\ar*1C'GS ^oun(^ *n the prisoner's possession, and for In t Ca.nnot account satisfactorily. ^Gces U? c'lcumstances, however, some corroboration is 'nirieH ai|^" "^n ^mPu^a^on of poisoning, it should be deter-Jiioii);'] ^ an accurate account of the symptoms, or by the the b ] aj)Pearances> whether poison was introduced into y before or after death;* and, granting that it was Vide OrfiJa, Toxicologic g?n<;ralc, ii. 681. taken daring life, whether it was the cause of death. Di " Christison quotes the two following cases from Germa works, in illustration of the necessity of the latter inquiry* A girl was severely chastised by her father, and die whilst the chastisement was being inflicted, and, as wa supposed by the father and others, from its effects. J-,ie bruises were severe, but it appeared to Wildberg, inade quate to cause death. He therefore examined the caviti?>> and found the stomach very much inflamed, and lined wit a white powder, which proved to be arsenic. It turne out that, on the theft, which the girl had committed, being detected, she swallowed arsenic, for fear of her father 9 anger; that she vomited during the flogging, and died m slight convulsions.
The other case occurred to Pyl, in 1783. A woman ?
Berlin, who lived on bad terms with her husband, went to bed in perfect health, but soon afterwards her mother found her breathing very hard, and discovered a wound on the left side of the breast. A surgeon being immediately sent for, the hemorrhage, which had never been great, checked without difficulty; but she died towards morning* On opening the chest, the wound was found to penetrate the pericardium, but did not reach the .heart; and, althoug" the fifth intercostal artery had been divided, scarcely ^ blood was effused into the chest. Coupling these circuit" stances with the trifling hemorrhage during life, and the fact that she had much vomiting and some convulsions 1*?' mediately before death, Pyl satisfied himself that she h? not died of the wound; and the signs of corrosion in tne mouth and throat, and of irritation of the stomach, with the discovery of the remains of some nitric acid in a glass in her room, proved that she had died of poison. (P. 49.) But," if poison be not detected in the body, the experimenter being; skilful, and the poison of a kind easily to discovered, still it must not be concluded, from that fact alofle> that poison has not been the cause of death; for it have been all discharged by vomiting and purging, ?r may have been all absorbed or decomposed.
1. It may have been discharged by vomiting or purginp* The case of a grocer is quoted in the Ne\v York Med. and Phil. Journal, vol. iii., who died eight hours after swallowing an ounce of arsenic, and in whose body none could be found by chemical analysis. It is singular, however, ho*V ineffectual vomiting sometimes proves in expelling some poisons from the stomach; for, after two days incessant vomiting, grains of arsenic have been found in the gullet o ft. n alti S?n W^l? surv've(l the taking of the poison four days l0ugh none could be found in other parts. abs' 1 '1G P?'son may have disappeared because it has been no ^ 1" a case in which the moral circumstances left ^ ( oubt that laudanum had been swallowed seven or eight aiTl' at ^?re none could be detected by Dr.Christison ; \vl v ^esrueMes has related the instance of a soldier, dr ?i in s'x hours and a half after swallowing two ? chms of solid opium, and in whose stomach nothing was u,U , a yellowish fluid, quite destitute of the smell of ^ drug. ^ Poisons may not be found because the excess has been ^composed. This is particularly the case with vegetable an>mal poisons, which may be altogether destroyed by co? ^r.0cess digestion. Some mineral poisons, such as a rr?s've sublimate, lunar caustic, hydrochlorate of tin, also decomposed in the stomach; but they are not re-o^Pv|"d beyond the reach of chemical analysis, for the basis Sfn, peison may be found in the solid contents of the I'"'1"" "'"J "C IUUI1U 111 111C OU11U VVIK.V1IVU V A >..u '<)ach; under some other compound form.
So decay of the body may render it impossible to detect Hie mercury, the mineral acids, opium, strychnia, veratrun1 album, prussic acid, cyanogen gas, sulphuretted hydro#? ' and many others, produce nearly the same effects on nia?> quadrupeds, birds, amphibious animals, and even on and on insects.
Hence there are cases in which the e deuce from experiments on animals with suspected artic of food, is unequivocal. In the case of Mary Bateman, who, after cheating a poor family for a series of years? ' last tried to avoid detection by poisoning-them, it was jus ) accounted good evidence that a portion of the pudding a? the honey supposed to have been poisoned caused violc vomiting in a cat, killed three fowls, and proved fatal to ^ dog in four days, under symptoms of irritation of the mach, such as were observed in the people who died.
in such a case a moderately skilful chemist could scai'?e J fail to detect the poison. ^ mil iu ueieci me puisuu. c 2. In the case of the matters vomited, or the contents the stomach, there are weightier objections to experimen on animals: for the poison which has caused death may have been partly or wholly vomited beforehand, or absoj ed, or transmitted into the intestines, or decomposed by 1 process of digestion; or, though abounding in the ma'tte vomited, or in that which remains in the stomach, it may ^ so much diluted as not to have any effect on an animal; 0^ the animal fluids secreted during disease are believed to a occasionally as poisons.
The last objection is a very important one, but, in ^ ' Christison's opinion, it has been a good deal exaggerate ? He refers to the repeated and fatal experience of aI1j1!?
mists, together with the precise experiments of ? Gaspard and Magendie for proofs of the poisonous eliec vjfcispuru ana magenaie ror proors or tlie poisonous eu?Ve of the animal fluids under disease; and he quotes also 11 ^ isolated case related by Morgagni, of a child who died tertian ag ue and in the midst of convulsions, in whose st ^ mach was found an aeruginous bile so deleterious that little of it given with bread to a cock caused convulsj0 and death in a few minutes, and a scalpel stained wit" J ' when thrust into the flesh of two pigeons, killed them in t same manner.
On the whole it appears that, in the p^e. having administered the poison ignorantly, or by acff'Vp or ^or beneficial purposes alleged or not alleged, do other members of the family besides the ceased having been similarly and simultaneously affected, the *l^USPiCi0US cont^uct on the part of the prisoner during recti ss the person poisoned; such as directly or indi--micss or me person poisoned; such as directly or indiectly preventing medical assistance being procured, or the e'ations of the dying person being sent for, or showing an ?ver-anxiety not to leave him alone with any other person, 0r attempting to remove or destroy articles of food or drink, Vomited matter which may have contained poison, or ex-Passing a foreknowledge of the probability of speedy death. , '? Suspicious conduct after the person's death; such as !astening the funeral, preventing or impeding the lnspec- especially such as tend to prove the impossibility or imp1"0 bability of suicide. t 9. The existence of a motive or inducement on the pa of the prisoner; such as his havinga personal quarrel vvi the deceased, or a hatred of him, his succeeding to propel > by his death, or being relieved of a burden by it; hiskn0>v ing that the deceased was with child by him, &c.
We have thus presented to our readers an outline ot tn most important of the general subjects discussed in the worv of Professor Christison. The opinion delivered by him, 111 opposition to almost all continental authorities, that tn symptoms alone, in certain cases of poisoning, are capa'-* of supplying decisive proof of the fact, is very importan^ and we think well sustained by some parts of the preceding abstract. The French, Germans, and others, have rt?' garded this species of proof too much like men of abstrac^ science, and with too little of common sense: for, grantnip that certain effects known to be the common results of cei' tain poisons may, by remote possibility, be occasioned hy natural disease, yet, if men engaged in extensive practice and after the most diligent literary research, cannot, Iroij1 their own experience, affirm, neither ascertain, that sue effects have ever happened in more than one or two doubt]}'instances, this remote possibility ought surely, in stn propriety, to have but the very slightest influence over 0 conclusions. We are aware that solemn consequences ? tend our decisions, and hence, in forming* them, extreme y cautious investigation and unbiassed judgment should eye be exercised; but, under their guidance, if, in certain cases; we did not ascribe certain symptoms to the agency ofpo's?M' v/e must depart from all our usual methods of reasoning-We designed to select a few of the subsequent chapterS for abstract and remark, in order to afford our readers son'? notions of the manner in which Dr. Christison has treats of the individual poisons; but our limits forbid, at presen? at least, the execution of our intention: and this we scarcely regret, as any condensed view offered by us couid not supersede the advantage, and indeed necessity, of consulting the original work. The treatment pointed out in the various chapters on the individual poisons, renders the work valuable to the general practitioner; while to the medical jurist, from the novelty, accuracy, and practical bearing' ot the facts so copiously collected, it is indispensable. In  sketch of some effects of loss of blood, and on exhaushi It will be apparent from this rapid enumeration of subjects of the first part of the work, that a new, interesting, and to a great extent unexplored, field of investig*1' Dr. M. Mali on the Effects of Loss of Blood.

1G9
anW"0 Proccet^ ^ie niore remote effects of loss of blood, 0 !j. st ?f exhaustion with reaction. The recovery from stal,nary sJncope is generally a simple return to a healthy bl e1?^ ^le ^unc^ons5 or nearly so. After profuse loss of Pe?? ^le recovery is not quite so uniform ; but in case the tinued .9ukjec^ to repeated bloodlettings, or to a confr pulse, instead of being slow and feeble, acquires a morbid aliq!lenCy anc* a ^robbing beat, and there are, in some instances, it .If ^ymptoms of excessive reaction. sj *"ls state of excessive reaction is formed gradually, and conof k' at ^rst? *n forcible beating of the pulse, of the carotids, and ivi) ? ^\eart> accompanied by a sense of throbbing in the head, of tli P!tation the heart, and eventually, perhaps, of beating or ?pj ?bhing in the scrobiculus cordis, and in the course of the aorta. ^lls state of reaction is augmented occasionally by a turbulent mental agitation, or bodily exertion ; at other times it is So c '".ed by a temporary faintness or syncope. There is also Retimes irregularity of the beat of the heart and of the pulse.
. *n the more exquisite cases of excessive reaction, the symp-.s are still more strongly marked, and demand a fuller der'ption. thr 1 temples is at length accompanied by a the v .? Pa'" ?f tlie head, and the energies and sensibilities of of ,? [ain are morbidly augmented ; sometimes there is intolerance turh ' ^ut st''^ more frequently intolerance of noise and of dis-, ance of any kind, requiring stillness to be strictly enjoined, the tlie i -t0 ant^ straw t0 be strewed along the pavement; ^ent ^eP 's a?'tated antl disturbed by fearful dreams, and the pajjjj ,,s hable to awake or be awoke in a state of great hurry of js i. > s?metimes almost approaching to delirium; sometimes there fre